Why Do We Worry About Measles in the Newborn Nursery?

Yes, this is about the Texas measles outbreak.

As measles outbreaks grow, your chance of getting exposed to measles grows too. Some new parents found that out the hard way this week, as their new babies were exposed to measles after a woman with measles gave birth to a baby in Texas.

Why Do We Worry About Measles in the Newborn Nursery?

Is that a big deal, being exposed to measles when you have just been born or have just had a baby?

“Here we present a rare case of a 34-day-old infant, who had a history of fever with a rash on the 18^th day of life and significant history of measles contact with mother and elder brother. The patient presented to us with septic shock and multiorgan involvement in the form of pneumonia, acute gastroenteritis with severe dehydration, mucopurulent conjunctivitis, and post-measles encephalitis.”

A rare presentation of measles and post-measles complications in a neonate: case report

It is a very big deal!

Both newborns and postpartum mothers are considered to be somewhat immunocompromised, at least they are relative to older children and adults. (Now that doesn’t mean that they are totally immunocompromised, so don’t believe the myths from anti-vaccine influencers that neither can nor should get vaccines!)

This 15 day old baby had a “severe disease course” after getting measles from his mother and spent 11 days in the PICU. Photo CC by 4.0.

And in the case of a postpartum mother with measles, that means that her baby doesn’t have any immunity to measles for protection. They will need to get a shot of immunoglobulin to try and help prevent them from developing measles, or at least hopefully have a milder course.

This is especially important because getting measles this young is thought to be a very big risk for later developing SSPE.

What about the other mothers, babies, and anyone that might have been exposed?

“Because infants are at higher risk for severe measles and complications, and infants are susceptible to measles if mothers are nonimmune or their maternal antibodies to measles have waned, IGIM should be administered to all infants aged <12 months who have been exposed to measles. For infants aged 6 through 11 months, MMR vaccine can be administered in place of IG if administered within 72 hours of exposure.”

Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Any other newborn babies should also get a shot of immunoglobulin as post-exposure prophylaxis, even if their mothers had been fully vaccinated and even if they had natural measles.

Why?

You don’t want to take a chance that they aren’t immune and aren’t protected!

Don’t want your baby to get an IG shot?

Then get two doses of the MMR vaccine before you get pregnant (if you didn’t get them on schedule when you were little…) and work to get everyone else protected too! #StopTheOutbreaks

References

Newborn babies exposed to measles in Texas hospital. https://www.nbcnews.com/health/health-news/texas-measles-outbreak-hospital-newborn-babies-exposed-rcna196519

Sharma, S.R., Sawant, V., Save, S.U. et al. A rare presentation of measles and post-measles complications in a neonate: case report. Egypt Pediatric Association Gaz 71, 59 (2023). https://doi.org/10.1186/s43054-023-00203-9

Sawaishi Y, Abe T, Yano T, Ishikawa K, Takada G. SSPE following neonatal measles infection. Pediatr Neurol. 1999 Jan;20(1):63-5. doi: 10.1016/s0887-8994(98)00100-3. PMID: 10029264.

Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). June 14, 2013 / 62(RR04);1-34 https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm

Parents of baby with measles in vaccination plea. https://www.bbc.com/news/articles/cldq5wdvqg7o

My Baby Has Measles